A study of psychiatric co-morbidity among alcohol dependents

Pankaj Kanwar, Ravi C. Sharma, Dinesh D. Sharma, Neeraj Kanwar


Background: The alcohol use disorders are frequently associated with other co-morbid psychiatric disorders. The aim of this study was to describe the demographic variables, drinking history and psychiatric co-morbidity in alcohol dependent subjects.

Methods: In this study, 40 consecutive patients were enrolled. After a minimum 1 month of sobriety, patients who fulfilled ICD-10 criteria of alcohol dependence were interviewed for data collection using Alcohol Use Disorders Identification Test (AUDIT), MINI-International Neuropsychiatric Interview (MINI) (Version-6.0) and a specially designed sociodemographic and clinical interview proforma. Subjects with substance use except tobacco were excluded from study. Main group comparison used chi-square test for categorical variables and the t-test for continuous variables.

Results: Most of the patients studied were >40 years of age. Majority were employed (92%), lived in nuclear families (78%) and came from rural background (77.5%). Forty five percent of the patients initiated alcohol drinking between 16-25 years and reported peer pressure (50%) as most significant factor responsible for initiation of drinking alcohol. Mean age of developing alcohol dependence was 25.12 years (SD=4.28). Mean AUDIT score for subjects was 27.7 (SD=4.73). Lifetime psychiatric co-morbid disorders were detected in 45%. Psychiatric disorders most frequently associated with alcohol dependence were major depressive disorder (10%), bipolar affective disorder (7.5%), dysthymia (5%), anxiety disorders (7.5%) and antisocial personality disorder (5%).

Conclusion: The study indicates that psychiatric disorders are prevalent in alcohol dependents and mood disorders are the most prevalent ones. It was also observed that co-morbid psychiatric disorders are associated with more severe alcohol problems.


Alcohol dependence, Co-morbidity, Dual diagnosis, Substance abusing mentally ill

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Babor TF, Hernandez-Avila CA, Ungemack JA. Substance abuse: alcohol use disorders. In: Tasman A, Kay J, Lieberman JA, First MB, Maj M eds. Psychiatry. 3rd ed. Chichester, U.K: John Wiley and Sons; 2008:971-1004.

Feinstein AR. The pretherapeutic classification of comorbidity in chronic disease. J Chronic Dis. 1970;23:455-68.

Rounsaville BJ, Dollinsky ZS, Babor TF, Mayor RE. Psychopathology as a predictor of treatment outcome. Arch Gen Psych. 1987;44:505-13.

Reis R. Clinical treatment matching models on dually diagnosed patients. Psychiatric clinics of North Am. 1993;16:167-75.

Winokur G, Coryell W, Endicott J, Keller M, Akiskal H, Solomon D. Familial alcoholism in manic-depressive illness. Am J Med Genet (Neuropsychiatric Genet). 1996;67:197-201.

Schuckit MA. Alcohol-related disorders. In: Sadock BJ, Sadock VA, Ruiz P eds. Kaplan and Sadock’s comprehensive textbook of psychiatry. 9th ed. Philadelphia: Lippincott Williams and Wilkins; 2009:1268-87.

World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.

Babor TF, de la Fuente JR, Saunders J, Grant M. Audit. The alcohol use disorders identification test: Guidelines for use in primary health care. Geneva: World Health Organization; 1989.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA; 1994.

Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, et al. The Mini International Neuropsychiatric Interview (M.I.N.I): The development and validation of a structured diagnostic psychiatric interview. J Clin Psych. 1998;59(20):22-33.

Kumar BPR, Dudala SR, Rao AR. Kuppuswamy’s socioeconomic status scale: a revision of economic parameter for 2012. Int J Res Development of Health. 2013;1(1):2-4.

Ross HE, Glaser FB, Germanson T. The prevalence of psychiatry disorders in patients with alcohol and other drug problems. Arch Gen Psy. 1988;45:1023-31.

Schuckit MA. The clinical implications of primary diagnostic groups among alcoholics. Arch Gen Psych. 1985;42:1043-49.

Pandey AK, Sapkota N, Tambi A, Shyangwa PM. Clinico-demographic profile, sexual dysfunction and readiness to change in male alcohol dependence syndrome inpatients in a tertiary hospital. Nepal Med Coll J. 2012;14(1):35-40.

Khalid A Kunwar AR, RajBhandari KC, Sharma VD, Regmi SK. A study of prevalence and comorbidity of depression in alcohol dependence. Indian J Psych. 2000;42:434-8.

Sarkar AP, Sen S, Mondal S, Singh OP, Chakraborty A, Swaika B. A study on socio demographic characteristics of alcoholics attending the de-addiction center at Burdwan Medical College and Hospital in West Bengal. Ind J Public Health. 2013;57(1):33-5.

Reddy MV, Chandrashekhar CR. Prevalence of mental and behavioural disorders in India: a meta-analysis. Indian J Psychiatry. 1998;40:149-57.

Singh NH, Sharma SG, Pasweth AM. Psychiatric comorbidity among alcohol dependents. Indian J Psychiatry. 2005;47:222-4.

Vohra AK, Yadav BS, Khurana H. A study of psychiatric comorbidity in alcohol dependence. Indian J Psychiatry. 2003;45:247-50.

Grant BF. The impact of a family history of alcoholism on the relationship between age at onset of alcohol use and DSM-IV alcohol dependence: Results from the national longitudinal alcohol epidemiologic survey. Alcohol Health Res World. 1998;22:144-7.

Gupta VK, Kaur P, Singh G, Kaur A, Sidhu BS. A study of profile of patients admitted in the drug de-addiction centers in the state of Punjab. Int J Res Health Sci. 2013;1(2):53-61.

Johnson PR, Banu S, Ashok MV. Severity of alcoholism in Indian males: correlation with age of onset and family history of alcoholism. Indian J Psychiatry. 2010;52(3):243-49.

Enoch MA, Goldman D. Problem drinking and alcoholism: diagnosis and treatment. Am Fam Phy. 2002;65(3):441-8.

Strat YL, Ramoz N and Gorwood P. In alcohol-dependent drinkers, what does the presence of nicotine dependence tell us about psychiatric and addictive disorders comorbidity? Alcohol & Alcoholism. 2010;45:167-72.

Chandini P, Mathai PJ. Prevalence of medical comorbidity in alcohol dependence syndrome. Muller Journal of Medical Sciences and Research. 2013;4(2):68-73.

Regier DA Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA. 1990;264:2511-8.

Kishore P, Lal N, Trivedi JK, Dalal PK, Aga VM. A Study of comorbidity in psychoactive substance dependence patients. Indian J Psychiatry. 1994;36:133-7.

Weissman MM, Myers JK, Harding PS. Prevalence and psychiatric heterogeneity of alcoholism in a United States urban community. J Stud Alcohol. 1980;41:672-81.

Hesselbrock MN, Mayor RE, Keener JJ. Psychopathology in hospitalized alcoholics. Arch Gen Psychiatry. 1985;42(11);1050-55.

Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997;54(4):313-21.

Bedi AR, Halikas JA. Alcoholism and Affective Disorder.Alcoholism: Clinical and Experimental Research. 1985;9:133-4.

Tyndel M. Psychiatric study of 100 alcoholic patients. Can J Psychiatry. 1974;19:21-4.